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S. Haque-Lobbes.Kinderarztpraxis, Vechelde, Germany

Background: Isolation of bacteria in respiratory tract infections (RTI) is virtually impossible in a paediatric primary care setting. Chest x ray, the standard for diagnosing lower respiratory tract infections (LRTI) is not usually available in the primary care clinic.

Aim: The object of this investigation was to assess the value of trans-thoracic ultrasonography in detecting lower respiratory tract infections in children.

Method: Restrospective review of all patients attending a single-handed general paediatric practice with RTI over a period of 22 months. Patients with clinical features of LRTI in whom antibacterial treatment would have been an option were selected as having at least two or more of the following: cough >1 week, fever >38.5°C, tachypnoea (adjusted for age) and inspiratory crackles. Trans-thoracic ultrasonography (US) was performed on these children by the same examiner using a 5 MHz probe. Patients with abnormal US scans also had chest x rays. Those with normal US scans were followed up clinically. Those with unequivocal US findings had a repeat US within 24–48 h to detect any rapid changes. All the patients who were clinically unwell to have US also had blood tests including Mycoplasma pneumoniae titres.

Results: From 01.01.2005 until 01.11.2006 there was a total of 883 children aged 0–<18 years who attended the surgery with RTI. 88 of these patients (9%) met clinical criteria for possible LRTI and were ultrasonically scanned. 33 children (3%) had evidence of either consolidation, pleural effusion or both on US. 6 of these had raised Mycoplasma pneumoniae titres (range: 1:340 to 1:1280, normal 1: <40). They were exempted from chest x rays and treated with Clarithromycin. In 3 children the parents declined x ray. Of the 24 patients with abnormal US changes who had chest x rays, 23 showed x ray changes which matched …

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